Pneumatic or hydraulic powered tissue closure devices

ABSTRACT

The present disclosure relates generally to systems, medical devices, and methods for closing an opening in a target tissue using hydraulics and/or pneumatics. In some embodiments, a medical device may include an endoscopic device operable to close an opening in a target tissue, and an actuator operable with the endoscopic device, wherein the actuator includes a piston within a chamber. The piston may include a piston head engaged with an interior surface of the chamber, and a piston rod coupled to a tissue engagement component of the endoscopic device, wherein pressure from a fluid within the chamber actuates the tissue engagement component.

CROSS-REFERENCE To RELATED APPLICATIONS

The present application claims the benefit of priority under 35 U.S.C. §119 to U.S. Provisional Patent Application No. 62/937,980, filed Nov.20, 2019, which application is incorporated herein by reference in itsentirety for all purposes.

FIELD

The present disclosure relates to the treatment of tissue defects, and,more particularly, to systems, devices, and methods for assisted tissueclosure.

BACKGROUND

In some medical procedures, it is beneficial to fixedly connect aportion of tissue to another portion of tissue, such as to hold togethera wound or damaged tissue. For example, one or more sutures or staplesmay be used to connect tissue portions. Often, an assembly, includingstaples, or a needle, and a suture coupled to the needle, is used tosecure tissue together.

Furthermore, both suturing and stapling closure methods are desirablefor tissue resection or various bariatric procedures. One drawback withsuturing and stapling systems is the challenge of deliverable force tothe distal end of the system. It is with these considerations in mindthat a variety of advantageous medical outcomes may be realized by thedevices, systems, and methods of the present disclosure.

SUMMARY

In one or more embodiments, a medical device may include an endoscopicdevice operable to close an opening in a target tissue and an actuatoroperable with the endoscopic device, the actuator including a pistonwithin a chamber. The piston may include a piston head engaged with aninterior surface of the chamber, and a piston rod coupled to a tissueengagement component of the endoscopic device, wherein pressure from afluid within the chamber actuates the tissue engagement component. Insome embodiments, the fluid is a gas or a liquid. In some embodiments,the actuator further comprises a valve operable to permit the fluid toenter the chamber, wherein the valve controls a flow of the fluidthrough an inlet conduit and an outlet conduit, and wherein the inletconduit and the outlet conduit are fluidly connected with the chamber.In some embodiments, the tissue engagement component is a needle passeror an endoscopic stapler head. In some embodiments, the endoscopicdevice is a suturing device, the suturing device including an elongatemember, and a suture arm at one end of the elongate member, wherein theneedle passer is operable to deliver a needle between the elongatemember and a distal end of the suture arm for suturing the targettissue. In some embodiments, the piston rod is disposed within aninterior of the elongate member, and wherein the piston rod is coupledto the needle passer. In some embodiments, the fluid within the chamberimpacts the piston head to actuate the piston rod and the needle passerin an axial direction. In some embodiments, the endoscopic stapler headmay include a first jaw opposite a second jaw, wherein the piston rod iscoupled to the first jaw, and a staple cartridge along the second jaw,wherein movement of the piston rod causes the first jaw to make or breakcontact with the staple cartridge. In some embodiments, the actuator mayfurther include a second piston within a second chamber, wherein thesecond chamber is fluidly connected with the first chamber, and whereina first diameter of the first chamber is larger than a second diameterof the second chamber. In some embodiments, the second piston mayinclude a second piston head engaged with an interior surface of thesecond chamber, and a second piston rod extending from the second pistonhead, wherein the second piston head faces the piston head.

In one or more embodiments, a system may include an endoscope and adevice including an actuator operable to close an opening in a targettissue. The actuator may include a piston within a chamber, the pistonincluding a piston head engaged with an interior surface of the chamber,and a piston rod coupled to a tissue engagement component of theendoscopic device, wherein pressure from a fluid within the chamberactuates the piston rod and the tissue engagement component. In someembodiments, the actuator may further include a valve operable to permitthe fluid to enter the chamber, wherein the valve controls a flow of thefluid through an inlet conduit and an outlet conduit fluidly connectedwith the chamber. In some embodiments, the device may further include asuturing needle passer or an endoscopic stapler head. In someembodiments, the device may be a suturing device, wherein the suturingdevice includes an elongate member and a suture arm at one end of theelongate member, wherein the tissue engagement component is a needlepasser operable to deliver a needle between the elongate member and adistal end of the suture arm for suturing the target tissue. In someembodiments, the device may be a stapler head, the stapler headincluding a first jaw opposite a second jaw, wherein the piston rod iscoupled to the first jaw, and a staple cartridge along the second jaw,wherein movement of the piston rod causes the first jaw to make or breakcontact with the staple cartridge. In some embodiments, the actuator mayfurther include a second piston within a second chamber, wherein thesecond chamber is fluidly connected with the first chamber, and whereina first diameter of the piston head is larger than a second diameter ofa second piston head of the second piston.

In one or more embodiments, a method may include inserting an endoscopicmedical device within a patient, the endoscopic medical device includingan endoscopic device operable to engage a target tissue, and an actuatorcoupled to the endoscopic device, the actuator including a piston withina chamber. The piston may include a piston head engaged with an interiorsurface of the chamber, and a piston rod coupled to a tissue engagementcomponent of the endoscopic device. The method may further includecontrolling an amount of a fluid within the chamber to actuate thepiston rod and the tissue engagement component relative to the targettissue, and engaging the target tissue with the tissue engagementcomponent to close an opening of the target tissue. The method mayfurther include engaging the target tissue using a suturing device, thesuturing device including an elongate member and a suture arm at one endof the elongate member, wherein the tissue engagement component is aneedle passer containing a needle. The method may further includedelivering the needle between the elongate member and a distal end ofthe suture arm to close the opening of the target tissue. The method mayfurther include engaging the target tissue using a stapler head, thestapler head including a first jaw opposite a second jaw, wherein thepiston rod is coupled to the first jaw, and actuating the piston rod toclose the first and second jaws about the target tissue to close theopening of the target tissue. The method may further include providing asecond piston within a second chamber, wherein the second chamber isfluidly connected with the first chamber, and wherein a first diameterof the piston head is larger than a second diameter of a second pistonhead of the second piston, and actuating the second piston to increase apressure of the fluid in the second chamber and the chamber.

Various one or more of the features summarized above, may beinterchanged, exchanged, combined, or substituted with, or for, otherfeatures summarized above, for use in connection with the medicalsystems and methods summarized above, and with respect to theembodiments described in greater detail below and embodiments otherwisewithin the scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

Non-limiting embodiments of the present disclosure are described by wayof example with reference to the accompanying figures, which are notintended to be drawn to scale. In the figures, each identical or nearlyidentical component illustrated is typically represented by a singlenumeral. For purposes of clarity, not every component is labeled inevery figure, nor is every component of each embodiment shown whereillustration is not necessary to allow those of ordinary skill in theart to understand the disclosure. Furthermore, some of the figuresinclude cross-sectional views in the form of “slices”, or “near-sighted”cross-sectional views, omitting certain background lines or featuresotherwise visible in a “true” cross-sectional view, for illustrativeclarity. In the figures:

FIG. 1 is a side cross-sectional view of an actuator of a medical deviceaccording to embodiments of the present disclosure;

FIG. 2A is a side view of an endoscopic device in a first stateaccording to embodiments of the present disclosure;

FIG. 2B is a side view of the endoscopic device of FIG. 2A in a secondstate according to embodiments of the present disclosure;

FIG. 3 is a side cross-sectional view of another actuator for use with amedical device according to embodiments of the present disclosure;

FIG. 4A is a side view of an endoscopic device in a first stateaccording to embodiments of the present disclosure;

FIG. 4B is a side view of the endoscopic device of FIG. 4A in a secondstate according to embodiments of the present disclosure;

FIG. 5 is a perspective view of an endoscopic stapler head according toembodiments of the present disclosure;

FIG. 6 is a perspective view of an endoscopic stapler head according toembodiments of the present disclosure; and

FIG. 7 is a flow diagram of a method according to embodiments of thepresent disclosure.

DETAILED DESCRIPTION

The present disclosure is not limited to the particular embodimentsdescribed herein. The terminology used herein is for the purpose ofdescribing particular embodiments only, and is not intended to belimiting beyond the scope of the appended claims. Unless otherwisedefined, all technical terms used herein have the same meaning ascommonly understood by one of ordinary skill in the art to which thedisclosure belongs.

One trend in medicine includes moving from laparoscopic and opensurgical procedures to miniaturized, endoscopic procedures. Endoscopistscan perform ever more complex procedures noninvasively and under directvisualization. As a result, there exists a need for endoscopic medicaldevices possessing specific built-in treatment capabilities. Suchmedical devices would facilitate both a broad range of proceduralinterventions more prevalent in hospitals, and further lead to thedevelopment of significantly more complex and capable scope designs.

Embodiments herein address at least the above deficiencies byintegrating complex functions into either a single-use scope or reusableendoscope. For example, the functions available according to thesystems, medical devices, and methods of the present disclosure mayinclude one or more of the following: suturing, stapling, cutting,cauterizing, clip deployment, injection, tissue manipulation, and more.Furthermore, by using the suture devices disclosed herein only a singletime, the infection risk can be greatly minimized.

The disclosure pertains to medical devices, e.g., endoscopes,gastroscopes, bronchoscopes, colonoscopes, ureteroscopes, endoscopicstapler heads, and the like, having integrated features for acquiring,manipulating, and closing openings in target tissue. Although single-useendoscope medical devices are described herein, it is understood thatembodiments of the present disclosure may be included in reusablemedical devices such as endoscopes as well. Embodiments herein addressat least the above deficiencies by integrating complex functions into asingle medical device.

Furthermore, embodiments herein address at least the above deficienciesof the prior art, such as the elevated level of force required toactuate a stapler head or push a needle through tissue. Prior artsystems use either pull wires or the force that an operator can apply bypushing and/or pulling on a catheter or similar. These prior artactuation methods can be unreliable in tortuous anatomy, translate toosmall a force to the distal end of the device, and/or be fatiguing tothe operator. Embodiments of the present disclosure enable higherforces, which may be required at a distal end of the medical device, byintroducing pneumatics and/or hydraulics into suturing or staplingdevices. Pneumatics and hydraulics can increase the force applied at aproximal end user interface, thus allowing distal end mechanisms to moreeasily puncture tissue or similar. Embodiments included herein describevarious configurations that support either suturing or stapling-baseddevices. However, it is recognized that the end use is not so limited,and the general ideas and designs may be applied to many similar devicesand end effectors requiring similar force and motions.

With reference to FIG. 1 , an actuator 102 of a system or endoscopicmedical device (hereinafter “device”) 100 according to embodiments ofthe disclosure will be described. As shown, the actuator 102 may includea piston 104 within a chamber 106, the piston 104 having a piston head108 connected with a piston rod 110. The piston head 108 may engage aninterior surface 111 of the chamber 106, generally dividing the chamber106 into a first portion 113, and a second portion 115. As shown, thefirst portion 113 of the chamber 106 may be fluidly connected with aninlet conduit 116, while the second portion 115 of the chamber 106 maybe fluidly connected with an outlet conduit 118. In some embodiments, apressure difference between the first portion 113 and the second portion115 of the chamber 106 will cause the piston 104 to move axially (e.g.,left or right in the figure) within the chamber 106.

The actuator 102 may further include a valve 120 operable to permit afluid 122 from a fluid supply 125 to enter and exit the chamber 106.More specifically, the valve 120 may control the flow of the fluid 122through both the inlet conduit 116 and the outlet conduit 118. Althoughnot shown, the valve 120 may be controlled at a handle or user interfaceof the device 100. In some embodiments, the outlet conduit 118 mayinclude one or more relief valves 121, while the inlet conduit 116 maybe connected to the fluid supply 125 for delivering the fluid 122 to thechamber 106. Although non-limiting, the fluid 122 may be pressured airor CO₂.

As shown, the piston rod 110 may be coupled to a tissue engagementcomponent 124. In non-limiting embodiments, as shown in FIGS. 2A and 2B,the tissue engagement component 124 may be a needle passer 126 of anendoscopic device, such as a suturing device 131. In some embodiments,the needle passer 126 may contain, or be coupled with, a needle 130operable to engage a target tissue. The device 100 may further includethe suturing device 131 coupled to the piston rod 110 of the actuator102. In some embodiments, the suturing device 131 may include anelongate member 134 coupled to, or integrally formed with, a suture arm136. The elongate member 134 may be a flexible hollow tube, endoscope,catheter, etc., and may include a proximal end 137 opposite a distal end138. In some embodiments, the elongate member 134 may be a flexiblematerial, such as silicone, a thermoplastic elastomer includingpolyamide and polyether backbone blocks, polyurethane, etc., to allowfor scope flexing. In other embodiments, the elongate member 134 may bea rigid material, such as polycarbonate, acrylonitrile butadiene styrene(ABS), etc., to provide a more direct positioning response.

In some embodiments, the suture arm 136 may be part of a distalassembly, including a body 141 having a proximal section 142 extendingfrom the distal end 138 of the elongate member 134. The proximal section142 and the elongate member 134 may be integrally connected such thatthe body 141 and the elongate member 134 form an integrated, single usedevice. In other embodiments, the distal assembly may be removablycoupleable to the elongate member 134 of a single use or a reusabledevice.

As further shown, the suture arm 136 may extend to an endcap 143, whichis configured to releasably engage and disengage the needle 130. In someembodiments, the needle 130 may be delivered by the needle passer 126between the distal end 138 of the elongate member 134 and the endcap143, which is located at a distal end 145 of the suture arm 136. Theneedle 130 may be connected to a suture (not shown) used for tensioningand closing an opening in a target tissue 146 (FIG. 2A) retained withina suture cavity 147 defined by the suture arm 136.

With reference to FIGS. 1, 2A, and 2B, operation of the device 100 willbe described in greater detail. In some embodiments, the device 100 maybe a pneumatic device employing a compressible fluid, such as air, todrive operation of the piston 104. Initially, the needle passer 126 andthe needle 130 may be recessed in a position adjacent the proximalsection 142 of the body 141, as demonstrated in FIG. 2A. Once the targettissue 146 is retained within the suture cavity 147, e.g., by a tissuegrasper (not shown) delivered through a channel of the body 141, thevalve 120 may be opened to cause an increase in the volume of the fluid122 within the first portion 113 of the chamber 106. As the volume ofthe fluid 122 increases, increased pressure upon the piston head 108causes the piston 104, the needle passer 126, and the needle 130 to bebiased towards the target tissue 146. The needle 130 may then puncturethe target tissue 146 before being retained within the endcap 143, asshown in FIG. 2B. Depending on the size and type of tissue opening, theneedle 130 may be passed back and forth between the proximal section 142and distal end 145 of the suture arm 136, the needle 130 including oneor more pointed tips for puncturing the target tissue 146 with eachpass.

Turning now to FIG. 3 , an actuator 202 of an endoscopic medical device(hereinafter “device”) 200 according to embodiments of the disclosurewill be described in greater detail. As shown, the actuator 202 mayinclude a first piston 204 within a first chamber 206, the first piston204 having a first piston head 208 connected with a first piston rod210. The first piston head 208 may extend across an entire interior areaof the first chamber 206, engaging an interior surface 211 thereof. Asshown, the first piston head 208 may generally divide the first chamber206 into a first portion 213 and a second portion 215.

As shown, the first portion 213 of the first chamber 206 may be fluidlyconnected with a second chamber 250 containing a second piston 252. Thesecond piston 252 may include a second piston head 254 engaged with aninterior surface 256 of the second chamber 250, and a second piston rod258 extending from the second piston head 254. In some embodiments, thesecond piston rod 258 may extend outside the second chamber 250. Asshown, the second piston head 254 faces the first piston head 208.

In some embodiments, a first diameter ‘D1’ of the first chamber 206 islarger than a second diameter ‘D2’ of the second chamber 250, therebyproviding a mechanical advantage, or force multiplication, during usesof the first and second pistons 204, 252. It will be appreciated thatthe device 200 may be a hydraulic device employing an incompressiblehydraulic liquid such as oil or water to drive operation of the firstand second pistons 204, 252. During use, a smaller input force on thesecond piston 252 results in a greater output force on the first piston204, thereby reducing an initial force required by a user. In someembodiments, the second piston 252 may be controlled by any variety ofactuators (e.g., a lever) located at a user interface (not shown).Furthermore, in other embodiments, one or more additional pistons may beemployed to provide more force multiplication.

With reference now to FIGS. 3, 4A, and 4B, an endoscopic stapler head260 according to embodiments of the present disclosure will bedescribed. As shown, the first piston rod 210 may be coupled to theendoscopic stapler head 260. In non-limiting embodiments, the endoscopicstapler head 260 includes a first jaw 262 opposite a second jaw 264. Thefirst jaw 262 and/or the second jaw 264 may be coupled to the firstpiston rod 210, for example, via one or more mechanical linkages 266(FIG. 3 ) for connecting the stapler head 260 to the actuator 202.

In some embodiments, the endoscopic stapler head 260 may include astaple cartridge 268 along an interior of the second jaw 264, whereinmovement of the first piston rod 210 causes the first jaw 262, sometimesreferred to as an anvil, to engage or disengage with the staplecartridge 268. The first and second jaws 262, 264 are pivotally attachedto one another to clamp a target tissue (not shown) to the staplecartridge 268. More specifically, the endoscopic stapler head 260 may beprovided in an initial position, as shown in FIG. 4A, in which the firstpiston rod 210 and the mechanical linkage 266 may be drawn back along afirst direction 273 (e.g., towards a handle or user interface). Themechanical linkage 266 may be connected to a biasing device (e.g., aslider) 282 having a first section 283 coupled to the second jaw 264 anda second section 284 coupled to or extending around the first jaw 262.In some embodiments, the second section 284 may include a shroud havingan opening for the first jaw 262. As the biasing device 282 movesrelative to the first jaw 262, an inner surface of the second section284 may engage an outer surface 287 of the first jaw 262, therebyforcing the first jaw 262 to close. In some embodiments, the first jaw262 also moves or pivots within the second section 284 of the biasingdevice 282 via a pin 271 of the first jaw 262 that slides within a pinslot 272 of the biasing device 282.

As further shown, the first section 283 of the biasing device 282 mayinclude a flange 288 engaged with a ledge 290 of the second jaw 264. Thebiasing device 282 may be further engaged with the second jaw 264 alonga second flange 292. Embodiments herein are not limited in this context,however.

In some embodiments, to open the endoscopic stapler head 260, the secondpiston 252 may be biased towards a proximal end 275 of the secondchamber 250, causing a decreased pressure within the second chamber 250and the first portion 213 of the first chamber 206. The decreasedpressure in turn may cause the first piston head 208 to move axiallytowards a proximal end 276 of the first chamber 206. As the first pistonhead 208 moves towards the proximal end 276 of the first chamber 206, sodoes the first piston rod 210 and the mechanical linkage 266, causingthe biasing device 282 to move along the first direction 273. Withoutthe second section 284 of the biasing device 282 engaged with the outersurface 287 of the first jaw 262, the first jaw 262 may be free to pivotaway from the second jaw 264, for example, in response to a spring forceor lever mechanism.

In other embodiments, the first piston rod 210 and the mechanicallinkage 266 may be coupled to the first jaw 262. During use, pulling thefirst piston rod 210 along the first direction 273 may pull the firstjaw 262 within the first section 283 of the biasing device 282 to lockthe first jaw 262 in a closed position. In some embodiments, a separatepiston rod (not shown), may be coupled to the biasing device 282 tostaple and cut tissue by the first and second jaws 262, 264 as thebiasing device 282 moves in a second direction 277 (e.g., away from ahandle or user interface).

To close the endoscopic stapler head 260, as depicted in FIG. 4B, thefirst piston rod 210, the mechanical linkage 266, and the biasing device282 may be biased in the second direction 277. To accomplish this, thesecond piston 252 may be biased towards a distal end 279 of the secondchamber 250, causing an increased pressure within the second chamber 250and the first portion 213 of the first chamber 206. The increasedpressure in turn may cause the first piston head 208 to move axiallytowards a distal end 280 of the first chamber 206. As the first pistonhead 208 moves towards the distal end 280 of the first chamber 206, sodoes the first piston rod 210 and the mechanical linkage 266, causingthe biasing device 282 to move in the second direction 277, thus causingthe first jaw 262 to pivot or rotate towards the second jaw 264.

As the endoscopic stapler head 260 closes, the first jaw 262 may deformstaples (not shown) driven up from staple holes in the staple cartridge268 into a closed shape. When the endoscopic stapler head 260 is in aclosed position, its cross-sectional area, as well as the first pistonrod 210, may be suitable for insertion through a small surgical opening,such as through a cannula of a trocar. Alternatively, the stapler head260 may be inserted into a body opening via attachment to the end of ascope, or inserted through a working channel of the scope. In someembodiments, correct placement and orientation of the endoscopic staplerhead 260 is facilitated by controls on the handle/user interface.

Although the endoscopic stapler head 260 is shown as being biased by theactuator 202, it will be appreciated that the endoscopic stapler head260 could be coupled to the actuator 102 shown in FIG. 2 and describedherein. For example, the piston rod 110 of the actuator 102 could becoupled to the mechanical linkage 266, which is used to control thefirst jaw 262. Alternatively, the suturing device 131 shown in FIGS. 2A-and 2B and described herein, could be biased by the actuator 202. Forexample, the first piston rod 210 may be coupled to the needle passer126. Embodiments herein are not limited in this context.

Turning to FIG. 5 , an alternative endoscopic stapler head 360 accordingto embodiments of the present disclosure, will be described. As shown,the endoscopic stapler head 360 may include a first jaw 362 opposite asecond jaw 364, and a biasing device 382 coupled to a piston rod 310,which may be the same or similar to the first piston rod 210 and/ormechanical linkage 266 of FIGS. 4A and 4B for connecting the staplerhead 360 to the actuator 202.

The biasing device (e.g., a slider) 382 may have a first section 383coupled to the first jaw 362 and a second section 384 coupled to thesecond jaw 364. In some embodiments, the first section 383 may include aflange 388 engaged with a protrusion or ledge 389 of the first jaw 362.During use, the piston rod 310 causes the biasing device 382 to movebetween a distal end 357 and a proximal end 358 of the endoscopicstapler head 360. As the biasing device 382 traverses along the firstjaw 362 and the second jaw 364, an inner surface of the second section384 may engage an outer surface 387 of the second jaw 364 to bring thefirst jaw 362 and the second jaw 364 together.

Turning to FIG. 6 , another alternative endoscopic stapler head 460according to embodiments of the present disclosure will be described. Asshown, the endoscopic stapler head 460 may include a first jaw 462opposite a second jaw 464, and a biasing device 482 coupled to a pistonrod 410, which may be the same or similar to the first piston rod 210and/or mechanical linkage 266 of FIGS. 4A- and 4B for connecting thestapler head 460 to the actuator 202.

Although shown disengaged with the first jaw 462 in FIG. 6 , the biasingdevice (e.g., a slider) 482 may have a first section 483 coupleable withthe first jaw 462 and a second section 484 coupled to the second jaw464. In some embodiments, the first section 483 may include a flange 488operable to slide along a protrusion or ledge 489 of the first jaw 462.During use, the piston rod 410 causes the biasing device 482 to movebetween a distal end 457 and a proximal end 458 of the endoscopicstapler head 460. As the biasing device 482 traverses along the firstjaw 462 and the second jaw 464, the first jaw 462 and the second jaw 464are brought together to staple and cut tissue.

In the non-limiting embodiment shown, the stapler head 460 may furtherinclude a pivot arm 492 coupled between the first jaw 462 and a secondpiston rod 494. The second piston rod 494 may be biased by an actuator,such as the actuator 102 or the actuator 202 described herein. The pivotarm 492 may be fixed to rotate about a pivot point 496, wherein movementof the second piston rod 494 towards the distal end 457 of the staplerhead 460 causes the first jaw 462 to open, and movement of the secondpiston rod 494 towards the proximal end 458 causes the first jaw 462 toclose.

FIG. 7 is a flow diagram of a method 500 according to embodiments of thepresent disclosure. At block 501, the method 500 may include insertingan endoscopic medical device within a patient, the endoscopic medicaldevice including an endoscopic device operable to engage a target tissueand an actuator coupled to the endoscopic device, the actuator includinga piston within a chamber. In some embodiments, the piston may include apiston head engaged with an interior surface of the chamber, and apiston rod coupled to a tissue engagement component of the endoscopicdevice. In some embodiments, the method may include providing a secondpiston within a second chamber, wherein the second chamber is fluidlyconnected with the first chamber, and wherein a first diameter of thepiston head is larger than a second diameter of a second piston head ofthe second piston. The method may further include actuating the secondpiston to increase a pressure of the fluid in the second chamber and thefirst chamber.

At block 503, the method may include controlling an amount of a fluidwithin the chamber to actuate the piston rod and the tissue engagementcomponent relative to the target tissue. In some embodiments, a valvemay be opened/closed to control the fluid entering the chamber. In someembodiments, the actuator may include an inlet conduit and an outletconduit fluidly connected with the chamber, wherein the inlet conduit ispositioned along a first side of the piston head, and wherein the outletconduit is positioned along a second side of the piston head.

At block 505, the method 500 may include engaging the target tissue withthe tissue engagement component to close an opening of the targettissue. In some embodiments, the method may include engaging the targettissue using a suturing device, the suturing device including anelongate member, and a suture arm at one end of the elongate member,wherein the tissue engagement component is a needle passer containing aneedle. The method may further include delivering the needle between theelongate member and a distal end of the suture arm to close the openingof the target tissue. In some embodiments, the method may includeengaging the target tissue using a stapler head, the stapler headincluding a first jaw opposite a second jaw, wherein the piston rod iscoupled to the first jaw. The method may further include actuating thepiston rod to close the first and second jaws about the target tissue toclose the opening of the target tissue.

It will be appreciated that a variety of different materials may be usedin forming the devices described herein. In some cases, a variety ofdifferent metals may be used. Illustrative but non-limiting examples ofsuitable metals include titanium, stainless steel, magnesium, cobaltchromium and others. In some embodiments, for example, the devicesdescribed herein may include any suitable polymeric material, includingbiocompatible materials such as polyurethane or silicone. Other suitablepolymers include but are not limited to polytetrafluoroethylene (PTFE),ethylene tetrafluoroethylene (ETFE), fluorinated ethylene propylene(FEP), polyoxymethylene (POM, for example, DELRIN® available fromDuPont), polyether block ester, polyurethane (for example, Polyurethane85A), polypropylene (PP), polyvinylchloride (PVC), polyether-ester (forexample, ARNITEL® available from DSM Engineering Plastics), ether orester based copolymers (for example, butylene/poly(alkylene ether)phthalate and/or other polyester elastomers such as HYTREL® availablefrom DuPont), polyamide (for example, DURETHAN® available from Bayer orCRISTAMID® available from Elf Atochem), elastomeric polyamides, blockpolyamide/ethers, polyether block amide (PEBA, for example availableunder the trade name PEBAX®), ethylene vinyl acetate copolymers (EVA),silicones, polyethylene (PE), Marlex high-density polyethylene, Marlexlow-density polyethylene, linear low density polyethylene (for exampleREXELL®), polyester, polybutylene terephthalate (PBT), polyethyleneterephthalate (PET), polytrimethylene terephthalate, polyethylenenaphthalate (PEN), polyetheretherketone (PEEK), polyimide (PI),polyetherimide (PEI), polyphenylene sulfide (PPS), polyphenylene oxide(PPO), poly paraphenylene terephthalamide (for example, KEVLAR®),polysulfone, nylon, nylon-12 (such as GRILAMID® available from EMSAmerican Grilon), perfluoro(propyl vinyl ether) (PFA), ethylene vinylalcohol, polyolefin, polystyrene, epoxy, polyvinylidene chloride (PVdC),poly(styrene-b-isobutylene-b-styrene) (for example, SIBS and/or SIBS50A), polycarbonates, ionomers, biocompatible polymers, other suitablematerials, or mixtures, combinations, copolymers thereof, polymer/metalcomposites, and the like.

Some embodiments may be described using the expression “coupled” and“connected” along with their derivatives. These terms are not intendedas synonyms for each other. For example, some embodiments may bedescribed using the terms “connected” and/or “coupled” to indicate thattwo or more elements are in direct physical or electrical contact witheach other. The term “coupled,” however, may also mean that two or moreelements are not in direct contact with each other, but yet stillco-operate or interact with each other.

Although non-limiting, as used herein with respect to the devicesherein, the term “proximal end” may refer to a portion of the device, ora portion of a component of the device, closest to a handle or userinterface of the device. The term “distal end” may refer to a portion ofthe device, or a portion of a component of the device, farthest from thehandle or user interface of the device.

As used herein, the singular forms “a,” “an,” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising,” or “includes” and/or “including” when used herein,specify the presence of stated features, regions, steps elements and/orcomponents, but do not preclude the presence or addition of one or moreother features, regions, integers, steps, operations, elements,components and/or groups thereof.

Furthermore, the terms “substantial” or “substantially,” as well as theterms “approximate” or “approximately,” can be used interchangeably insome embodiments, and can be described using any relative measuresacceptable by one of skill. For example, these terms can serve as acomparison to a reference parameter, to indicate a deviation that willstill provide the intended function. Although non-limiting, thedeviation from the reference parameter can be, for example, in an amountof less than 1%, less than 3%, less than 5%, less than 10%, less than15%, less than 20%, and so on.

Although specific embodiments have been illustrated and describedherein, it should be appreciated that any arrangement calculated toachieve the same purpose may be substituted for the specific embodimentsshown. This disclosure is intended to cover any and all adaptations orvariations of various embodiments. It is to be understood that the abovedescription has been made in an illustrative fashion, and not arestrictive one. Combinations of the above embodiments, and otherembodiments not specifically described herein will be apparent to thoseof skill in the art upon reviewing the above description. Thus, thescope of various embodiments includes any other applications in whichthe above compositions, structures, and methods are used.

Still furthermore, although the illustrative method 500 is describedabove as a series of acts or events, the present disclosure is notlimited by the illustrated ordering of such acts or events unlessspecifically stated. For example, some acts may occur in differentorders and/or concurrently with other acts or events apart from thoseillustrated and/or described herein, in accordance with the disclosure.In addition, not all illustrated acts or events may be required toimplement a methodology in accordance with the present disclosure.

Although the subject matter has been described in language specific tostructural features and/or methodological acts, it is to be understoodthat the subject matter defined in the appended claims is notnecessarily limited to the specific features or acts described above.Rather, the specific features and acts described above are disclosed asexample forms of implementing the claims.

What is claimed is:
 1. A medical device, comprising: an endoscopicdevice operable to close an opening in a target tissue; and an actuatoroperable with the endoscopic device, the actuator including: a pistonwithin a chamber, the piston comprising: a piston head engaged with aninterior surface of the chamber; and a piston rod coupled to a tissueengagement component of the endoscopic device, wherein pressure from afluid within the chamber actuates the tissue engagement component and asecond piston within a second chamber, wherein the second chamber isfluidly connected with the chamber, wherein a first diameter (D1) of thefirst chamber is larger than a second diameter (D2) of the secondchamber.
 2. The medical device of claim 1, the actuator furthercomprising a valve connected to a fluid supply, wherein the valvecontrols a flow of the fluid through an inlet conduit and an outletconduit, and wherein the inlet conduit and the outlet conduit arefluidly connected with the chamber.
 3. The medical device of claim 1,wherein the tissue engagement component is a needle passer or anendoscopic stapler head.
 4. The medical device of claim 3, theendoscopic stapler head comprising: a first jaw opposite a second jaw,wherein the piston rod is coupled to the first jaw; and a staplecartridge along the second jaw, wherein movement of the piston rodcauses the first jaw to make or break contact with the staple cartridge.5. The medical device of claim 1, the second piston comprising: a secondpiston head engaged with an interior surface of the second chamber; anda second piston rod extending from the second piston head, wherein thesecond piston head faces the piston head.
 6. A system, comprising: anendoscope; and a device including an actuator operable to close anopening in a target tissue, the actuator including a piston within achamber, the piston comprising: a piston head engaged with an interiorsurface of the chamber; and a piston rod coupled to a tissue engagementcomponent of the endoscopic device, wherein pressure from a fluid withinthe chamber actuates the piston rod and the tissue engagement component;and a second piston within a second chamber, wherein the second chamberis fluidly connected with the chamber, wherein a first diameter (D1) ofthe chamber is larger than a second diameter (D2) of the second chamber.7. The system of claim 6, the actuator further comprising a valveoperable to control a flow of the fluid through an inlet conduit and anoutlet conduit fluidly connected with the chamber.
 8. The system ofclaim 6, the device comprising a suturing needle passer or an endoscopicstapler head.
 9. The system of claim 6, wherein the device is a staplerhead, the stapler head comprising: a first jaw opposite a second jaw,wherein the piston rod is coupled to the first jaw; and a staplecartridge along the second jaw, wherein movement of the piston rodcauses the first jaw to make or break contact with the staple cartridge.10. A method, comprising: inserting an endoscopic medical device withina patient, the endoscopic medical device comprising: an endoscopicdevice operable to engage a target tissue; and an actuator coupled tothe endoscopic device, the actuator including: a piston within achamber, the piston comprising: a piston head engaged with an interiorsurface of the chamber; and a piston rod coupled to a tissue engagementcomponent of the endoscopic device; and a second piston within a secondchamber, wherein the second chamber is fluidly connected with thechamber, wherein a first diameter (D1) of the chamber is larger than asecond diameter (D2) of the second chamber; controlling an amount of afluid within the chamber to actuate the piston rod and the tissueengagement component relative to the target tissue; and engaging thetarget tissue with the tissue engagement component to close an openingof the target tissue.
 11. The method of claim 10, further comprising:engaging the target tissue using a stapler head, the stapler headincluding a first jaw opposite a second jaw, wherein the piston rod iscoupled to the first jaw; and actuating the piston rod to close thefirst and second jaws about the target tissue to close the opening ofthe target tissue.
 12. The method of claim 10, wherein a first diameterof the piston head is larger than a second diameter of a second pistonhead of the second piston; and actuating the second piston to increase apressure of the fluid in the second chamber and the chamber.